AB0770 MANAGING MEDICATION WITHDRAWAL IN ANCA ASSOCIATED VASCULITIS, A SINGLE CENTRE STUDY
Authors: A. Abdalla, S. Skeoch
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> While ANCA- associated vasculitis (AAV) can be a life-threatening condition, once patients achieve sustained remission, it is possible to withdraw glucocorticoids (GC) and immunosuppressive therapy successfully. British <sup>[1]</sup> and European <sup>[2]</sup> guidelines advocate withdrawal of therapy in sustained remission. However, robust definitions of remission and risk of relapse on drug withdrawal are active research areas within the vasculitis community. Therefore, we took the opportunity to review &amp; compare the clinical practice at our Tertiary Vasculitis Centre to guidelines published by the British Society for Rheumatology (BSR) <sup>[1]</sup>. <h3>Objectives</h3> To describe the proportion of patients in remission and rates of drug withdrawal in line with BSR guidelines and evaluate if any characteristics were associated with GC-dependent remission. <h3>Methods</h3> We conducted a retrospective records review of all AAV patients (clinical diagnosis regardless of classification criteria) in our centre who attended for their routine care between July 2015 – August 2020. Those who lost or lacked significant follow-up information were excluded. Approval by the local clinical audit department was granted. Remission was defined per BSR guidance as a well-controlled disease by physician assessment on drug or drug-free remission. SPSS v.25 was used for statistical analysis. <h3>Results</h3> Sixty-five patients were included, 58% female, mean (SD) age at diagnosis of 60.7 (13.2), and 92% were Caucasians. The median (range) disease duration was five years (0.5 – 43). 33.8% were classified as GPA, 29.2% as EGPA. 55.4% had life or organ threatening disease, and 50.8% with a relapsing disease (table 1). At the time of the study, 60% of patients remained on GCs and 89% on immunosuppressive therapy. 48/65 (74%) were in clinical remission, of whom 19/48 (39.6%) were on GC plus immunosuppression, 21/48 (43.8%) were on immunosuppression alone, and 5/48 (10.4%) were in drug-free remission. In those with disease duration ≥ 10 years (n=14), 50% were deemed high relapse risk or poorly controlled and remained on a median dose of 10mg prednisolone. On univariate and multiple logistic regression analysis (reference=GC-dependent), skin involvement and a positive biopsy (83.3% non-renal) were associated with a statistically significant lower odds (OR 0.127 <i>P</i>=0.006, OR 0.207 <i>P</i>=0.04 respectively) of remaining on long term GC. In contrast, the relapsing disease was associated with increased odds (OR 4.006, <i>P</i>=0.026) of GC-dependent remission (figure 1). <h3>Conclusion</h3> Withdrawing treatment in AAV is challenging and achievable in a minority of patients, while the vast majority remain on long-term treatment. Skin involvement and non-renal positive biopsy may carry a positive prospect toward GC-free remission. Age, gender, disease type, ANCA status or persistent ANCA did not significantly influence the potential to stay on GC. Having a relapsing disease is the single most crucial factor significantly associated with long term treatment. <h3>References</h3> [1]Ntatsaki E, et al. BSR guidelines (2014), <i>Rheumatology (Oxford</i>) [2]Yates M, et al. EULAR guidelines (2016), <i>ARD.</i> <h3>Acknowledgements</h3> Data team and the clinical audit department at the RUH NHS trust, Bath. <h3>Disclosure of Interests</h3> None Declared.